Lanreotide — Drug Monograph

Brand names: Somatuline Depot, Somatuline Autogel

Drug class: Somatostatin Analog

Mechanism of Action

Long-acting synthetic somatostatin analogue with high affinity for somatostatin receptor subtypes SSTR2 and SSTR5 (similar to octreotide). Supplied as a deep subcutaneous depot formulation (aqueous gel) requiring injection every 4 weeks. The extended-release mechanism (liquid crystal gel technology) allows slow drug release from the SC depot, sustaining therapeutic plasma levels for 28 days from a single injection. Antiproliferative effects in NETs are mediated through direct inhibition of tumor cell growth (SSTR2-mediated) and indirect effects via inhibition of GH/IGF-1, VEGF, and…

FDA Indications

• Unresectable, well- or moderately-differentiated, locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) to improve progression-free survival — FDA approved December 2014 (CLARINET trial)
• Acromegaly — in patients for whom medical therapy is appropriate, including those inadequately controlled by surgery or radiation therapy

Common Side Effects

• Diarrhea, flatulence, loose stools
• Cholelithiasis (gallstones) — similar rate to octreotide (~50% long-term)
• Injection site reactions (pain, nodule, induration at injection site)
• Abdominal pain
• Nausea
• Glucose metabolism abnormalities (hypo- or hyperglycemia)
• Bradycardia

Clinical Pearl

The CLARINET trial was pivotal: 120 mg lanreotide every 4 weeks demonstrated a 53% reduction in risk of disease progression or death (HR 0.47, p<0.001) vs. placebo in non-functioning, well- or moderately-differentiated GEP-NETs with a Ki-67 ≤10%. Crucially, the benefit was seen across pancreatic and midgut NET subtypes. Lanreotide and octreotide LAR are considered therapeutically interchangeable for most NET indications; the choice between them is often driven by patient preference (injection…

Related Therapies & Mechanisms

• Octreotide Acetate (Sandostatin) — Somatostatin Analog · NET
• Capecitabine (Xeloda) — NET
• CAPTEM Regimen (Capecitabine + Temozolomide) (Xeloda + Temodar) — NET
• Everolimus (Afinitor) — NET